E really is for emergency, more hospitals say - page 2
E really is for emergency, more hospitals say Two First Coast hospitals now charge extra for non-emergency ER visits.... Read More
Dec 7, '06Occupation: RN, ER Case management, precertification. Specialty: ICU-Stepdown ; Joined: Dec '02; Posts: 862; Likes: 53I think its a good start. I know that during my last year in EMS, we began to charge extra for emergencies that weren't. But we were having something of a problem with people making claims that they then changed (claiming they were having chest pains or heart attacks, whatever- when in fact they were just feeling bad (had the flu, a cold, whatever) and wanted the ambulance to take them because they believed they would get seen faster (they wouldn't. We would just triage them and put 'em in the waiting room if they weren't real emergencies) -they were doing this because they wanted the ambulance to get to them NOW.
That was back in '95. I don't know if they still do it or not (charge extra).
Dec 7, '06Occupation: Nurse Educator, psych forensic hosp Specialty: 45 year(s) of experience in pure and simple psych ; Joined: Mar '05; Posts: 804; Likes: 120Quote from krisoLOL-I think this would be a MAJOR concern in my hospital
Too bad the MAJOR concern is not prompt and appropriate PATIENT CARE:trout: !
Dec 7, '06Occupation: ER Nurse - Pedi and Adult Specialty: 6 year(s) of experience in Tele, ICU, ER ; From: US ; Joined: Aug '06; Posts: 502; Likes: 96I note that this hospital chain doing this is a for-profit hospital. Since I work in a county hospital, I can see this co-pay thing simply shunting more patients my way. <sigh>
I DO agree that non-emergency folks should pay at the time of service, but I wish it would include EVERYONE, not just at profit hospitals (our county hospital would never ever ever get away with it).
And, in my ER on nights, we only have one ER doc on duty - no PAs or NPs. So for him to do the screening, he would be taking time from the ones already in the back. Does sound like this is an answer for us.. darn it.
Dec 7, '06Occupation: RN, ER Case management, precertification. Specialty: ICU-Stepdown ; Joined: Dec '02; Posts: 862; Likes: 53Quote from sanctuaryI would think that you might realize that part of the reason that there ISN'T prompt and appropriate PATIENT CARE is because the emergency room is overburdoned by people who treat it as their walk-in clinic instead of what it really is -an EMERGENCY room. If the system wasn't so overburdoned by non-emergencies, perhaps the waiting time wouldn't number in the hours.Too bad the MAJOR concern is not prompt and appropriate PATIENT CARE:trout: !
I've only worked in an ER at a small facility, and the majority of the time, the patients werent 'true' emergencies (not that the facility I worked in could handle much in the way of a 'true' emergency anyway) -but I do know that when I worked in EMS, MOST of the 'emergencies' weren't really emergencies. Folks literally used us as just another transport to the hospital in the belief that using the ambulance would help 'em bypass the waiting list.
It didn't, really. At least not in OUR system, but that was the common belief.
Dec 7, '06Occupation: travel Specialty: 16 year(s) of experience in ICU,CCU,Trauma, neuro, geriatrics, telem ; Joined: Jul '04; Posts: 971; Likes: 349In the USA we need anxiety ERs.
Dec 7, '06Occupation: RN Specialty: 20 year(s) of experience in Critical care ; From: US ; Joined: Jan '02; Posts: 807; Likes: 669I think that sanctuary's comment was directed to another comment stating that a MAJOR concern at their hospitals would be the Press Gainey score. I don't believe it had anything to do with the patient care aspect.
Dec 7, '06Occupation: RN Joined: Apr '04; Posts: 441; Likes: 23Great idea! I think they should ask for the money up front before being seen and in cash or credit card...no checks (might bounce). Because we all know that even if they agree to it, there are many who will, after treatment, walk out without paying.
I live & work in our state's capital and we have three major hospitals within our downtown area. Many a night, especially the cold or bad weather nights, our ERs fill up with homeless people who are basically trying to get in out of the cold, get some free food, free narcotics (for make believe pain and they're "allergic to Darvocet"), etc. They missed curfew or were intoxicated, so they weren't allowed in the homeless shelters. I have even heard some with my own ears say that they use the ER as their "regular doctor" and they make their "appointments" in the middle of the night. Not really meaning they actually make an appointment, but just show up then.
Dec 9, '06Occupation: ED Nurse Joined: Mar '03; Posts: 49; Likes: 2One of the best things our ED has done is go to a 5-level triage system in which we triage throughout the stay. The most acute patient is treated first. It's time for Press/Gainey to start doing some homework on the acuity of the ED patients they survey. They should either stop surveying non-acute ED patients, discarding the surveys from non-acute ED patients or stop surveying ED patients altogether. PG SUX.
Dec 9, '06Occupation: ED Nurse Joined: Mar '03; Posts: 49; Likes: 2BTW, another aspect of this issue that ticks me off is management's response that the non-acute patient is such a big part of our revenue. That's fine except for the fact that, ultimately, via higher insurance premiums or taxes, I'm the one paying for them.
Dec 9, '06Occupation: RN, ER Case management, precertification. Specialty: ICU-Stepdown ; Joined: Dec '02; Posts: 862; Likes: 53Yep. Thats why I used to get so annoyed with patients who thought of the Ambulance as a "free ride" -they had no intention of paying. I was going to be footing that bill through taxes and higher insurance premiums. There is NO such thing as a 'free ride'.
Dec 9, '06Occupation: Research RN Specialty: 7 year(s) of experience in Oncology, Research ; Joined: Feb '04; Posts: 333; Likes: 112Yeah, this may sound good initially. But as one post alluded to earlier, who are the majority of these people who are abusing the services of the ED? A great deal of them do not have good access to health care, let alone insurance. So we are adding an extra fee for those who already are never going to pay. That means more unrecovered monies which will eventually drive the price of healthcare up for the rest of us.
Dec 9, '06Occupation: Haemetology nurse Specialty: Oncology/Haemetology/HIV ; From: US ; Joined: May '02; Posts: 7,040; Likes: 7,483Quote from snowfreezeActually we need an ER vending machineIn the USA we need anxiety ERs.Last edit by caroladybelle on Dec 9, '06
Dec 9, '06Occupation: Haemetology nurse Specialty: Oncology/Haemetology/HIV ; From: US ; Joined: May '02; Posts: 7,040; Likes: 7,483Actually we need a ER vending machine.
With one row of narcotics.
One row of sedatives.
One row of excuses for getting off work.
One row of pregnancy tests and emergency contraceptives.
Two rows of antibiotics: Divided into the "I've coughing for days/have walking pneumonia" and the others, "My trouser snake/virginey hurts/burns- no, of course I have been having only safe sex". "No I haven't been unfaithful. Really!"
One row for the dizzy all over/chest pain younguns that wait until they have completed $5K of tests to say "I don't know WHY this ALWAYS happens after I use cocaine/crack/crystal/ecstasy.
One row containing " 3 hot meals and a cot" and a room for "I need to get away from the kids/my husband"
And one row of certifications for disability.
You insert medicaid/medicare/insurance card.
You have the patient answer appropriate questions on a computer pad - and item from Row C - item #4 drops out.
But then would we have such interesting stories.